Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-03T02:11:28.962Z Has data issue: false hasContentIssue false
  • English
  • Français

Echocardiographic measured shunt velocity does not predict pulmonary blood flow in patients with Blalock–Thomas–Taussig shunt

Published online by Cambridge University Press:  02 August 2023

Sarah Tucker Open the ORCID record for Sarah Tucker [Opens in a new window] ,
Matthew Cornicelli ,
Rohit Loomba ,
Jeremy Fox ,
Eric Wald  and
Jamie Penk
Sarah Tucker*
Affiliation:
Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Matthew Cornicelli
Affiliation:
Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Rohit Loomba
Affiliation:
Department of Cardiac Critical Care, Advocate Health Care, Chicago, IL, USA
Jeremy Fox
Affiliation:
Department of Interventional Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Eric Wald
Affiliation:
Department of Critical Care, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Jamie Penk
Affiliation:
Department of Cardiac Critical Care, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
*
Corresponding author: Sarah Tucker; Email: stucker@luriechildrens.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Catheterisation is the gold standard used to evaluate pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt. It involves risk and cannot be performed frequently. This study aimed to evaluate if echocardiographic measurements obtained in a clinical setting correlate with catheterisation-derived pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt as the sole source of pulmonary blood flow.

Methods:

Chart review was performed retrospectively on consecutive patients referred to the catheterisation lab with a Blalock–Thomas–Taussig shunt. Echocardiographic parameters included peak, mean, and diastolic gradients across the Blalock–Thomas–Taussig shunt and forward and reverse velocity time integral across the distal transverse aorta. In addition to direct correlations, we tested a previously published formula for pulmonary blood flow calculated as velocity time integral across the shunt × heart rate × Blalock–Thomas–Taussig shunt area. Catheterisation parameters included pulmonary and systemic blood flow as calculated by the Fick principle.

Results:

18 patients were included. The echocardiography parameters and oxygen saturation did not correlate with catheterisation-derived pulmonary blood flow, systemic blood flow, or the ratio of pulmonary to systemic blood flow. As the ratio of reverse to forward velocity time integral across the transverse aorta increased, the probability of shunt stenosis decreased.

Conclusion:

Echocardiographic measurements obtained outside the catheterisation lab do not correlate with catheterisation-derived pulmonary blood flow. The ratio of reverse to forward velocity time integral across the transverse aortic arch may be predictive of Blalock–Thomas–Taussig shunt narrowing; this finding should be investigated further.

Keywords

Blalock–Thomas–Taussig shuntpulmonary blood flowvelocity time integral
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 3 , March 2024 , pp. 535 - 539
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rychik, J, Bush, D, Spray, T, Gaynor, JW, Wernovsky, G. Assessment of pulmonary/systemic blood flow ratio after first-stage palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2000; 120: 81–87. DOI: 10.1067/mtc.2000.106840.Google Scholar
DeGroff, C, Shandas, R, Kwon, J, Valdes-Cruz, L. Accuracy of the Bernoulli equation for estimation of pressure gradient across stenotic Blalock-Taussig shunts: an in vitro and numerical study. Pediatr Cardiol 2000; 21: 439–447. DOI: 10.1007/s002460010104.CrossRefGoogle Scholar
Tacy, T, Whitehead, K, Cape, E. In vitro Doppler assessment of pressure gradients across modified Blalock-Taussig shunts. Am J Cardiol 1998; 81: 1219–1223. DOI: 10.1016/s0002-9149(98)00096-4.Google Scholar
Faherty, E, Rajagopal, H, Lee, S, et al. Correlation of transthoracic echocardiography-derived pulmonary to systemic flow ratio with hemodynamically estimated left to right shunt in atrial septal defects. Ann Pediatr Cardiol 2022; 15: 10–4103. DOI: 10.4103.Google Scholar
Chaudhari, M, Balmer, C, Heng, JT, Wright, J, Stumper, O. Usefulness of Blalock-Taussig shunt Doppler flow velocity profiles in the assessment of pulmonary artery pressure and flow. Eur J Echocardiogr 2004; 5: 10–1016. DOI: 10.1016/s1525-2167(03)00052-0.Google Scholar